Dissociative Fugue

Dissociative fugue is a psychological state in which a person loses consciousness of their identity or other essential autobiographical information, which is accompanied by unexpected and rapid travel and, in some cases, the establishment of a new identity.

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What Is Dissociative Fugue?

Dissociative fugue, formerly known as psychogenic fugue, is a type of dissociative disorder. Dissociative fugue is a form of reversible amnesia that involves personality, memories, and personal identity. This type of temporary amnesia may last hours, days, weeks, months, or longer. It involves wandering or unplanned travel, in which the person may establish a new identity in a new location very different from their old life.

The word fugue is derived from a Latin word for “flight.” Individuals with this condition temporarily lose their sense of personal identity and impulsively wander or travel away from their homes or places of work. They often confused about their actual identity and may even create a new identity while suffering from an episode. However, what makes it difficult to observe this condition is the fact that such patients do not exhibit any signs of illness, a strange appearance, or odd behavior. The symptoms can also interfere with a person’s general functioning, including social and work activities, and relationships as well.

As per a study [mfn] Raval, C. M., Upadhyaya, S., & Panchal, B. N. (2015). Dissociative fugue: Recurrent episodes in a young adult. Industrial psychiatry journal, 24(1), 88–90. https://doi.org/10.4103/0972-6748.160944 [/mfn], dissociative fugue is a ”rare psychiatric disorder identified by sudden or unexpected traveling from one’s customary place of living or work”. Traumatic events resulting in an altered state of consciousness backed by a wish to flee are assumed to be the underlying cause. Additionally, the personality split is the underlying defense mechanism used by an individual to cope with traumatic memories. Given the fact that it is a rare disorder, the prevalence rate of dissociative fugue is nearly 0.2% [mfn] Mamarde, A., Navkhare, P., Singam, A., & Kanoje, A. (2013). Recurrent dissociative fugue. Indian journal of psychological medicine, 35(4), 400–401. https://doi.org/10.4103/0253-7176.122239 [/mfn] across the population.

If the fugue is a brief episode, the person simply misses some work or comes home late. If the fugue lasts several days or longer, the person tends to travel far from home, forms a new identity, and begins a new job, ignorant of any change in his/her life.

Again, in many cases, fugues appear to represent a hidden wish-fulfilment or the only possible way to escape from stress or embarrassment. Thus, the dissociative fugue is often misunderstood as malingering (faking physical or psychological symptoms to obtain a benefit) as both conditions can give people an excuse to avoid their responsibilities, accountability for their actions, or to reduce their exposure to a known hazard. However, doctors can usually identify the two conditions separately as malingerers intensify and dramatize their symptoms or fake memory loss.

Causes Of Dissociative Disorder

Dissociative fugue is a condition that is caused by an extremely emotionally stressful situation. It is assumed that the condition occurs as the means for a person to escape the stress that they can’t otherwise cope with. A common cause of dissociative fugue is severe sexual trauma of some sort. Other causes may include:

Intense emotions of shame or embarrassment
Trauma caused by an accident
Some sort of a shock caused by war
Trauma caused by a natural disaster
Kidnapping and torture
Long-term emotional or physical abuse in childhood

It must be noted that the trauma can either actually happen to the victim, or he/she may have witnessed some incident happening to others that have left the person severely traumatized. In addition, it is also assumed that there may be a genetic link as any family member of the person with a dissociative disorder is more likely to experience the condition. Also, while the person may look normal after the initial trauma, reminders of an earlier trauma could trigger dissociative fugue.

A study [mfn] Igwe M. N. (2013). Dissociative fugue symptoms in a 28-year-old male Nigerian medical student: a case report. Journal of medical case reports, 7, 143. https://doi.org/10.1186/1752-1947-7-143 [/mfn] represents a case where it was reported that dissociative fugue is often related to stressful life events and can occur with a comorbid depressive disorder. The case study is about a 28-year old patient who is a male final year medical student from the South-Eastern region of Nigeria. He was missing for ten days as his whereabouts were unknown. Prior to this incident, the patient was extremely stressed as he was under severe economic and academic pressures.

In fact, while studying in his room alone at night, the patient reported witnessing a full human skeleton reading at the same table with him on the opposite side. At the same time, the patient claimed he felt uneasy and uncomfortable. He saw the whole room turning with everything inside becoming unstable and unreal. After this, he experienced overwhelming fears and after two days, he discovered himself with his younger sibling in South-Western Nigeria, which is 634km away from his university. As far as the brother is concerned, he had reported that the patient looked dirty and exhausted but was fully conscious and alert on arrival at his house without any assistance.

Symptoms Of Dissociative Fugue

As we have mentioned previously, dissociative fugue may last for a few hours and during this time, the concerned person may appear confused and forgetful to others. However, once this phase fades away, the person comes back to his normal self. It may be possible that such a short duration of dissociative fugue might even go unnoticed by others.

However, when the condition tends to last for weeks, months, and sometimes even longer, a person may experience the following symptoms.

1. During the Fugue State

When a person is in the midst of a fugue state, he/she may show the following symptoms:

Uncertainty about their identity
Looking unsure about their past
Feeling defied if questioned about their identity

However, when a person is in the middle of the dissociative fugue, he/she may not exhibit any outward signs that will imply that he/she is experiencing mental illness. It is because, from the person’s point of view, the new identity is his/her actual identity. It is only when this is confronted that concerns may present themselves.

2. After the Fugue State Ends

Upon the passing of a dissociative fugue state, a person may experience the following.

Discomfort or anger
Stages of grief
Feelings of depression
A feeling of a loss
Feelings of embarrassment
Feelings of distress about being in an unfamiliar place

In many cases, the concerned person may also walk away from their current life to start a new life which is absolutely different from their previous lifestyle.

Read More About Embarrassment Here

Diagnosis Of Dissociative Fugue

Before we jump to the method of diagnosis of dissociative fugue, let us go through the set of criteria made for the diagnosis of this condition.

1. Diagnosis Criteria As Per DSM-IV

When dissociative fugue was originally considered as a separate disorder in DSM-IV, the following criteria had to be met for diagnosis.

Abrupt or unforeseen journey away from one’s home or work
The incapability to memorize your past experiences
Confusion about one’s identity and taking on a new one
Notable distress and impairment about these issues

However, it must be noted that dissociative fugue is only diagnosed retrospectively, as the concerned person when in the middle of the condition may not show any outward signs, thereby making it hard for others to recognize the disorder. Therefore, once the fugue ends, it is then that the diagnosis is usually made.

2. Diagnosis Criteria As Per DSM-5

Since the release of the DSM-5, the dissociative fugue became a subtype of dissociative amnesia (a disorder) and relates to the symptoms of dissociative amnesia followed by the state of purposeful travel or bewildered wandering.

There are other different types of amnesia that be combined with this condition, such as:

Localized amnesia
Systematized amnesia
Generalized amnesia
Selective amnesia
Continuous amnesia

Read More About DSM 5 Here

3. Diagnostic Exclusions

The condition will not be diagnosed if the fugue state is associated directly with any of the following conditions or situations, such as:

Head trauma
A general medication condition
Ingestion of psychotropic substances
Diagnosis of delirium
Dissociative identity disorder
Diagnosis of dementia
Diagnosis of epilepsy
Ingestion of drugs or alcohol

Furthermore, in very rare cases, people may pretend to suffer from dissociative fugue in order to escape legal or other reasons.

4. Methods Of Diagnosis

To diagnose dissociative fugue, a few assessments are conducted which would generally start with a medical and neurological examination. If indicated, a neuroimaging study of the brain, such as MRI, or additional tests such as an electroencephalogram (EEG) is conducted to rule out other conditions like epilepsy. Once physical causes are eliminated, a psychiatrist or psychologist would conduct a series of assessment tools along with an interview to evaluate whether the symptoms are best accounted for by a diagnosis of fugue.

Treatment Of Dissociative Fugue

Since the duration of episodes varies, some may resolve rapidly, while others can continue for years. There may be multiple episodes as well.

The treatment goal of dissociative fugue is divided into two parts.

To help recover the person’s identity and foster coping strategies to stop the same thing from occurring again.
To help one come to terms and face the original trauma that had triggered the episode.

Treatment Methods

There are various treatment options that can be implemented to treat a person with dissociative fugue. These are:

Psychotherapy- to understand the person’s thinking patterns
Medication- to treat related depression and anxiety
Family Therapy- to help receive support from the close ones
Art Therapy- to explore feelings in a safe way
Clinical Hypnosis
Eye Movement Desensitization & Reprocessing (EMDR)- to manage flashbacks, and symptoms of post-traumatic stress
Dialectical Behavior Therapy (DBT)- to treat possibly overwhelming feelings
Meditation or Relaxation Techniques- to treat symptoms and observe one’s internal state.

Unfortunately, without treatment of the underlying issue, dissociative fugue may happen multiple times.

Coping With Dissociative Fugue

Dissociative fugue is one such condition where the person may be aware of the fact that he/she is at all suffering from a mental disorder. Thus, coping with this condition is a challenge in itself. However, if a person has experienced episodes in the past, there are a few things he/she can do to check recurrence. These are:

Getting therapy to cope with the symptoms
Understanding the underlying issue of the condition through therapy
Taking help and support of the family members to help you with the condition
Reducing or eliminate possible triggers of a dissociative fugue
Engaging in meditation or other techniques to calm and manage the internal states
Obtaining a creative outlet for one’s emotions
Taking medicines on time and the dose, as prescribed by the doctor

Read More About Meditation Here

How To Help Someone With Dissociative Fugue?

If someone close to you has been diagnosed with dissociative fugue, here are a few suggestions to help that person with this condition.

Accompany the concerned person to his/her therapy sessions to gather information about the disorder and how you can offer support.
Identify potential triggers and be sensitive to those along with understanding how they might affect the person with the condition.
Make sure that the patient is receiving all the love, care, and support along with taking all prescribed medications as directed by the psychiatrist.

Is It Possible To Prevent Dissociative Fugue?

Preventing dissociative fugue is not a possible task, however, an early treatment plan can help manage the symptoms from getting worse. Additionally, a quick intervention after a traumatic event or an episode might help reduce the risk of aggravating the disorder.

Our Final Words

Dissociative is a complex, rare type of dissociative amnesia and it requires more research to handle this condition better. If a person is living with dissociative fugue, he/she must know that he/she is not alone in this journey as there are others experiencing the same condition. As for the family members are concerned, they must make sure to arrange a treatment to prevent the same thing from happening again.